The second stage of labor is the pushing stage. It begins when your cervix is fully dilated to 10 centimeters and ends when your baby is born. This is the stage where you actively work to push your baby through the birth canal and into the world. For first-time mothers, it typically lasts anywhere from 30 minutes to 3 hours, while those who have given birth before often complete it in under 2 hours.
What Happens During the Second Stage
Once your cervix is fully open, contractions shift in purpose. Instead of working to dilate the cervix (the job of the first stage), they now push the baby downward through the pelvis and birth canal. You’ll feel intense pressure, and most people experience a strong, involuntary urge to bear down and push. This urge is driven by what’s called the Ferguson reflex: as the baby’s head stretches the cervix and vaginal walls, nerve signals travel to the brain and trigger a surge of oxytocin, which intensifies contractions even further. It creates a powerful feedback loop where each push moves the baby lower, which increases the stretch, which drives stronger contractions.
As the baby descends, it doesn’t simply drop straight down. The baby performs a series of coordinated movements to navigate the curves and narrow points of the pelvis. These include tucking the chin to the chest (flexion), rotating to fit the widest part of the head through the widest part of the pelvis (internal rotation), then tilting the head back as it emerges under the pubic bone (extension). After the head is delivered, the baby rotates one final time so the shoulders can pass through. These movements happen naturally in response to the shape of the birth canal, not from anything you consciously do.
Near the very end of the second stage, you’ll feel an intense burning or stretching sensation as the baby’s head crowns, meaning the widest part becomes visible at the vaginal opening. Your care team may ask you to slow your pushing at this point to give the tissue time to stretch gradually, which can reduce tearing.
How Long It Lasts
Duration varies significantly depending on whether this is your first birth. The American College of Obstetricians and Gynecologists defines a prolonged second stage as more than 3 hours of pushing for first-time mothers and more than 2 hours for those who have given birth before. These thresholds account for the fact that first-time mothers have pelvic floor muscles and tissues that haven’t been stretched by a previous delivery, so the baby’s descent takes longer.
An epidural also affects timing. Because it reduces sensation in the lower body, the urge to push can be dulled, and each effort may be less efficient. Older clinical guidelines set stricter time limits (2 hours for first-timers with an epidural, 1 hour without), but current guidelines allow an additional hour beyond those older cutoffs. A large study of more than 19,000 patients found that giving people that extra hour reduced the rate of cesarean delivery, though it came with a modest increase in other complications like more severe tearing.
Spontaneous vs. Directed Pushing
There are two main approaches to pushing. With directed pushing, a nurse or midwife coaches you through each contraction, typically telling you to take a deep breath, hold it, and push hard for about 10 seconds, repeating two to three times per contraction. With spontaneous pushing, you follow your body’s signals and push when and how you feel the urge, breathing and bearing down at your own rhythm.
Research comparing the two approaches has found that directed pushing doesn’t actually shorten the second stage. In fact, it was associated with a longer pushing phase for both first-time and experienced mothers. Directed pushing was also linked to higher rates of episiotomy (a surgical cut to widen the vaginal opening) and an increased likelihood that the newborn needed resuscitation or nursery admission. These findings suggest that for most people without an epidural, following your body’s natural cues is at least as effective and possibly safer. If you have an epidural and can’t feel the contractions well, some coaching may be helpful simply because the urge to push is harder to detect.
How Position Affects Pushing
The position you push in can make a meaningful difference. A systematic review of 25 randomized trials involving nearly 10,000 first-time mothers found that upright positions (standing, walking, using a birth stool) were the most effective at shortening the second stage, followed closely by free positioning, where you move between whatever feels most comfortable. Both were significantly better than lying flat on your back in the traditional lithotomy position.
Upright and free positions take advantage of gravity, open the pelvic outlet wider, and give you more control over your movement. Kneeling and squatting, while intuitively appealing, actually ranked lower than upright or semi-recumbent (propped-up) positions in the analysis. Side-lying fell in the middle of the pack. The practical takeaway: if your birth setting and any monitoring needs allow it, staying mobile and upright during pushing tends to work in your favor.
When the Second Stage Takes Longer
Several factors can slow things down. A baby in a posterior position (facing your abdomen instead of your spine) has to rotate further to navigate the pelvis, which adds time. A larger baby, a narrow pelvis, exhaustion from a long first stage, or a dense epidural that limits your ability to feel and respond to contractions can all extend the pushing phase.
If pushing stalls and the baby isn’t making progress, your care team has a few options. Assisted delivery uses a vacuum cup placed on the baby’s head or specially shaped forceps to help guide the baby out during your contractions. These tools are used when the baby is close to delivery but needs additional help, and the procedure requires an experienced operator who has confirmed exactly how the baby’s head is positioned, sometimes using ultrasound for accuracy. If assisted delivery isn’t appropriate or doesn’t succeed, a cesarean delivery becomes the next step.
Progress is typically measured not just by time but by whether the baby continues to descend with each pushing effort. As long as the baby is moving down and both of you are tolerating labor well, the second stage is generally allowed to continue beyond the standard time thresholds.
What It Feels Like
The second stage feels distinctly different from the first. Many people describe the transition as a shift from waves of pain (contractions dilating the cervix) to overwhelming pressure low in the pelvis, similar to the urge to have a bowel movement. This rectal pressure is completely normal and is caused by the baby’s head pressing against the same area. Contractions during pushing may actually feel more productive and less painful than those during late first-stage labor, because you’re actively working with them instead of breathing through them passively.
Between contractions, there are brief rest periods where the pressure eases. As the baby moves lower, the sensation intensifies, and the stretching and burning at crowning is often the most intense moment of the entire labor. Once the head is delivered, the rest of the body usually follows within one or two more contractions, and the pressure and pain drop dramatically and almost immediately.